MEDICARE: MISS AZLEA VANESSA BENNINGTON RN-FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	731203	TX

General Provider Information

NPI Number	:	1215229059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AZLEA VANESSA BENNINGTON RN-FNP

Provider Business Mailing Address
First Line	:	1010 VIRGINIA DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-7341
Country	:	US
Telephone Number	:	941-806-8872
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 S OSPREY AVE
Second Line	:	SUITE 5
City	:	SARASOTA
State	:	FL
Zip	:	34239-2938
Country	:	US
Telephone Number	:	941-554-2149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	03/20/2013

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